Provider Demographics
NPI:1922032424
Name:SACRED HEART HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SYSTEM, INC.
Other - Org Name:SACRED HEART HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:COBA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-416-6206
Mailing Address - Street 1:7928 SOLUTION CTR
Mailing Address - Street 2:LOCKBOX 777928
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7009
Mailing Address - Country:US
Mailing Address - Phone:850-416-7000
Mailing Address - Fax:850-416-6119
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7000
Practice Address - Fax:850-416-6119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
FL26583416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010020OtherBCBS-AL INSTITUTIONAL
FL403OtherBCBS-FL INSTITUTIONAL
ALHOS0025PMedicaid
FL010076500Medicaid
FL126095800OtherUSDOL WORKERS COMP
FL5000183OtherUHC INSTITUTIONAL
FL010076500Medicaid
FL010076508Medicaid
FL010076500Medicaid
FL403OtherBCBS-FL INSTITUTIONAL